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Long ZB, Punn R, Zhang Y, Arunamata AA, Asija R, Ma M, Hanley FL, McElhinney DB. Right Ventricular and Outflow Tract Functional Characteristics After Repair of Tetralogy of Fallot with Major Aortopulmonary Collaterals. Pediatr Cardiol 2024; 45:795-803. [PMID: 38360921 DOI: 10.1007/s00246-024-03412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
This study describes right ventricle (RV) characteristics and right ventricle to pulmonary artery (RV-PA) conduit function pre- and post-repair in patients with tetraology of Fallot with major aortopulmonary collaterals (TOF/MAPCAs). We reviewed patients who underwent single-stage, complete unifocalization, and repair of TOF/MAPCAs between 2006 and 2019 with available pre- and early postoperative echocardiograms. For a subset of patients, 6-12 month follow-up echocardiogram was available. RV and left ventricle (LV) characteristics and RV-PA conduit function were reviewed. Wilcoxon signed rank test and McNemar's test were used. 170 patients were reviewed, 46 had follow-up echocardiograms. Tricuspid valve annular plane systolic excursion (TAPSE) Z-scores were reduced from pre- (Z-score 0.01) to post-repair (Z-score -4.5, p < 0.001), improved but remained abnormal at follow-up (Z-score -4.0, p < 0.001). RV fractional area change (FAC) and LV ejection fraction were not significantly different before and after surgery. Conduit regurgitation was moderate or greater in 11% at discharge, increased to 65% at follow-up. RV-PA conduit failure (severe pulmonary stenosis or severe pulmonary regurgitation) was noted in 61, and 63% had dilated RV (diastolic RV area Z-score > 2) at follow-up. RV dilation correlated with the severe conduit regurgitation (p = 0.018). Longitudinal RV function was reduced after complete repair of TOF/MAPCAs, with decreased TAPSE and preserved FAC and LV ejection fraction. TAPSE improved but did not normalize at follow-up. Severe RV-PA conduit dysfunction was observed prior to discharge in 11% of patients and in 61% at follow-up. RV dilation was common at follow-up, especially in the presence of severe conduit regurgitation.
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Affiliation(s)
- Zsofia B Long
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA.
- Pediatric Cardiology, Stanford University School of Medicine, 750 Welch Road, Suite 325, Palo Alto, CA, 94304-5731, USA.
| | - Rajesh Punn
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Yulin Zhang
- Clinical and Translational Research Program, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Alisa A Arunamata
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Ritu Asija
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Doff B McElhinney
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
- Clinical and Translational Research Program, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
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Williams JL, Dodeja AK, Boe B, Samples S, Alexander R, Hor K, Lee S. Impact of pulmonary stenosis on right ventricular global longitudinal strain in repaired tetralogy of Fallot patients post transcatheter pulmonary valve replacement. Echocardiography 2024; 41:e15765. [PMID: 38341768 DOI: 10.1111/echo.15765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Mixed pulmonary disease with pulmonary regurgitation (PR) and stenosis (PS) in repaired tetralogy of Fallot (rTOF) can negatively impact ventricular health. Myocardial strain has been shown to be more sensitive at detecting occult ventricular dysfunction compared to right ventricular ejection fraction (RV EF). We hypothesize that rTOF patients with predominant PS will have lower RV global longitudinal strain (RV GLS) prior to and post-transcatheter pulmonary valve replacement (TPVR). METHODS A retrospective cohort of rTOF patients who underwent cardiac magnetic resonance (CMR) and cardiac catheterization for right ventricular pressure (RVSP) measurement were analyzed at three time points: before valve implantation, at discharge and within 18 months post-TPVR. Patients were dichotomized into three groups based on RVSP: 0%-49%, 50%-74%, and >75%. RV GLS and left ventricular (LV) GLS by speckle tracking echocardiography (STE) were obtained from the apical 4-chamber using TomTec software (TOMTEC IS, Germany). RESULTS Forty-eight patients were included. Every 14.3% increase in preimplantation RVSP above 28% was associated with an absolute magnitude 1% lower RV GLS (p = .001). Preimplantation RVSP when 75% or higher had 3.36% worse RV GLS than the lowest bin (p = .014). Overall, average RV strain magnitude was higher when preimplantation RVSP was less than 50% and had greater improvement over the three time points. Higher post implantation RVSP correlated with lower strain magnitude. CONCLUSION Patients with significant PS (>50%) may benefit from earlier PVR and not depend solely on RV size and EF. Myocardial strain may be a more sensitive marker of function; however, larger, prospective studies are needed.
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Affiliation(s)
- Jason L Williams
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Anudeep K Dodeja
- Division of Pediatric Cardiology, Connecticut Children's Hospital, Hartford, Connecticut, USA
| | - Brian Boe
- Division of Pediatric Cardiology, Joe DiMaggio Children's Hospital Heart Institute, Hollywood, Florida, USA
| | - Stefani Samples
- Division of Pediatric Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Robin Alexander
- Center for Biostatistics, The Ohio State College of Medicine, Columbus, Ohio, USA
| | - Kan Hor
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Simon Lee
- Division of Pediatric Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Avitabile CM, Flohr S, Mathew L, Wang Y, Ash D, Frank DB, Tingo JE, Rintoul NE, Hedrick HL. Quantitative Measures of Right Ventricular Size and Function by Echocardiogram Correlate with Cardiac Catheterization Hemodynamics in Congenital Diaphragmatic Hernia. J Pediatr 2023; 261:113564. [PMID: 37329980 PMCID: PMC11164033 DOI: 10.1016/j.jpeds.2023.113564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To evaluate associations between cardiac catheterization (cath) hemodynamics, quantitative measures of right ventricular (RV) function by echocardiogram, and survival in patients with congenital diaphragmatic hernia (CDH). STUDY DESIGN This single-center retrospective cohort study enrolled patients with CDH who underwent index cath from 2003 to 2022. Tricuspid annular plane systolic excursion z score, RV fractional area change, RV free wall and global longitudinal strain, left ventricular (LV) eccentricity index, RV/LV ratio, and pulmonary artery acceleration time were measured from preprocedure echocardiograms. Associations between hemodynamic values, echocardiographic measures, and survival were evaluated by Spearman correlation and Wilcoxon rank sum test, respectively. RESULTS Fifty-three patients (68% left-sided, 74% liver herniation, 57% extracorporeal membrane oxygenation, 93% survival) underwent cath (39 during index hospitalization, 14 later) including device closure of a patent ductus arteriosus in 5. Most patients (n = 31, 58%) were on pulmonary hypertension treatment at cath, most commonly sildenafil (n = 24, 45%) and/or intravenous treprostinil (n = 16, 30%). Overall, hemodynamics were consistent with precapillary pulmonary hypertension. Pulmonary capillary wedge pressure was >15 mm Hg in 2 patients (4%). Lower fractional area change and worse ventricular strain were associated with higher pulmonary artery pressure while higher LV eccentricity index and higher RV/LV ratio were associated with both higher pulmonary artery pressure and higher pulmonary vascular resistance. Hemodynamics did not differ based on survival status. CONCLUSIONS Worse RV dilation and dysfunction by echocardiogram correlate with higher pulmonary artery pressure and pulmonary vascular resistance on cath in this CDH cohort. These measures may represent novel, noninvasive clinical trial targets in this population.
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Affiliation(s)
- Catherine M Avitabile
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Sabrina Flohr
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Leny Mathew
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Yan Wang
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Devon Ash
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - David B Frank
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jennifer E Tingo
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Natalie E Rintoul
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Holly L Hedrick
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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Keelan J, Pasumarti N, Crook S, Decost G, Wang Y, Crystal MA, Shah A, Bacha E, Mercer-Rosa L, DiLorenzo M. Right Ventricular Strain in Patients With Ductal-Dependent Tetralogy of Fallot. J Am Soc Echocardiogr 2023; 36:654-665. [PMID: 36933850 PMCID: PMC10281045 DOI: 10.1016/j.echo.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Right ventricular (RV) dysfunction is an independent predictor of poor outcomes in patients with tetralogy of Fallot (TOF), and global longitudinal strain (GLS) is a well-validated echocardiographic technique to measure RV function. Although trends in RV GLS have been examined in patients with TOF, they have not been studied specifically in those with ductal-dependent TOF, a group in which there is not a clear consensus on the best surgical strategy. The aim of this study was to assess the midterm trajectory of RV GLS in patients with ductal-dependent TOF, drivers of this trajectory, and differences in RV GLS between repair strategies. METHODS This was a retrospective two-center cohort study of patients with ductal-dependent TOF who underwent repair. Ductal dependence was defined as being initiated on prostaglandin therapy and/or undergoing surgical intervention on or before 30 days of life. RV GLS was measured on echocardiography preoperatively, early after complete repair, and at 1 and 2 years of age. RV GLS was trended over time and compared between surgical strategies and with control subjects. Mixed-effects linear regression models were used to evaluate the factors associated with changes in RV GLS over time. RESULTS Forty-four patients with ductal-dependent TOF were included in the study, of whom 33 (75%) underwent primary complete repair and 11 (25%) underwent staged repair. Complete TOF repair was performed at a median of 7 days in the primary-repair group and 178 days in the staged-repair group. RV GLS improved over time from post-complete repair echocardiography through 2 years of age (-17.4% [interquartile range, -15.5% to -18.9%] vs -21.5% [interquartile range, -18.0% to -23.3%], P < .001). However, compared with age-matched control subjects, patients had worse RV GLS at all time points. There was no difference in RV GLS between the staged and primary complete repair groups at 2-year follow-up. Shorter intensive care unit length of stay after complete repair was independently associated with improvement in RV GLS over time. Strain improved by 0.07% (95% CI, 0.01 to 0.12) for each fewer day in the intensive care unit (P = .03). CONCLUSIONS RV GLS improves over time among patients with ductal-dependent TOF, though it is consistently reduced compared with control subjects, suggesting an altered deformation pattern in patients with ductal-dependent TOF. There was no difference in RV GLS between the primary- and staged-repair groups at midterm follow-up, suggesting that repair strategy is not a risk factor for worse RV strain in the mid postoperative period. A shorter complete-repair intensive care unit length of stay is associated with an improved trajectory of RV GLS.
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Affiliation(s)
- Jenna Keelan
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
| | - Nikhil Pasumarti
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Sarah Crook
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Grace Decost
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yan Wang
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew A Crystal
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Amee Shah
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Emile Bacha
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Laura Mercer-Rosa
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael DiLorenzo
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
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Jones AL, Faerber J, Huang J, Ampah S, Wang Y, DeCost G, Gardner M, Naim MY, Reddy S, Goldmuntz E, Mercer-Rosa L. Biomarkers, Socioeconomic Factors, and Right Ventricular Function After Surgical Repair for Tetralogy of Fallot. Pediatr Cardiol 2023:10.1007/s00246-023-03108-x. [PMID: 36797379 PMCID: PMC10330615 DOI: 10.1007/s00246-023-03108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/19/2023] [Indexed: 02/18/2023]
Abstract
Right ventricular (RV) dysfunction early after tetralogy of Fallot (TOF) increases post-operative morbidity. We investigated associations of circulating biomarkers and socioeconomic factors with early post-operative RV systolic function. Single-center prospective cohort study of infants undergoing TOF repair. Six serologic biomarkers of myocardial fibrosis and wall stress collected at the time of surgery were measured with immunoassay. Geocoding was performed for socioeconomic factors. Multivariate adaptive regression splines (MARS) models identified factors associated with RV function parameters: fractional area change (FAC), global longitudinal strain and strain rate, and free wall strain and strain rate. Seventy-one patients aged 3.5 months (IQR 2.4, 5.2) were included. Galectin-3 was the highest ranked predictor for FAC, global longitudinal strain, and free wall strain, and procollagen type-I carboxy-terminal propeptide (PICP) was the highest ranked predictor for global longitudinal strain rate and free wall strain rate. Several neighborhood characteristics were also highly ranked. Models adjusted R2 ranged from 0.71 to 0.85 (FAC, global longitudinal strain/strain rate), and 0.55-0.57 (RV free wall strain/strain rate). A combination of serologic biomarkers, socioeconomic, and clinical variables explain a significant proportion of the variability in RV function after TOF repair. These factors may inform pre-operative risk-stratification for these patients.
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Affiliation(s)
- Andrea L Jones
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Jennifer Faerber
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Jing Huang
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Steve Ampah
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Yan Wang
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Grace DeCost
- Women and Infants Hospital of Rhode Island, Providence, RI, 02905, USA
| | - Monique Gardner
- Division of Critical Care Medicine, Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Maryam Y Naim
- Division of Critical Care Medicine, Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Sushma Reddy
- Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital and Stanford University, Palo Alto, CA, 94304, USA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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Ekhomu O, Faerber JA, Wang Y, Huang J, Mai AD, DiLorenzo MP, Bhatt SM, Avitabile CM, Mercer-Rosa L. Right atrial function early after tetralogy of Fallot repair. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1961-1972. [PMID: 37726603 DOI: 10.1007/s10554-022-02595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
Diastolic dysfunction after repair for Tetralogy of Fallot (TOF) is associated with adverse long-term outcomes. Right atrial (RA) mechanics as a proxy of right ventricular (RV) diastolic function in the early post-operative period after surgical repair for TOF has not been reported. We sought to evaluate RA and RV strain prior to hospital discharge after TOF repair and to identify important patient factors associated with strain using a machine learning method. Single center retrospective cohort study of TOF patients undergoing surgical repair, with analysis of RA and RV strain from pre-and post-operative echocardiograms. RA function was assessed by the peak RA strain, systolic RA strain rate, early diastolic RA strain rate and RA emptying fraction. RV systolic function was measured by global longitudinal strain. Pre- and post-operative values were compared using Wilcoxon rank sum test. Gradient boosted machine (GBM) models were used to identify the most important predictors of post-operative strain. In total, 153 patients were enrolled, median age at TOF repair 3.5 months (25th-75th percentile: 2.2- 5.2), mostly male (67%), and White (64.1%). From pre-to post-operative period, there was significant worsening in all RA parameters and in RV strain. GBM models identified patient, anatomic, and surgical factors that were strong predictors of post-operative RA and RV strain. These factors included pulmonary valve and branch pulmonary artery Z scores, birth weight, gestational age and age at surgery, pre-operative RV fractional area change and oxygen saturation, type of outflow tract repair, duration of cardiopulmonary bypass, and early post-operative partial arterial pressure of oxygen. There is significant worsening in RA and RV strain early after TOF repair, indicating early alteration in diastolic and systolic function after surgery. Several patient and operative factors influence post-operative RV function. Most of the factors described are not readily modifiable, however they may inform pre-operative risk-stratification. The clinical application of RA strain and the prognostic implication of these early changes merit further study.
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Affiliation(s)
- Omonigho Ekhomu
- Division of Cardiology, Rush University Children's Hospital, Chicago, IL, USA
| | - Jennifer A Faerber
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yan Wang
- Division of Cardiology, Echocardiography Laboratory, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jing Huang
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anh Duc Mai
- Division of Cardiology, Echocardiography Laboratory, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael P DiLorenzo
- Division of Cardiology, Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Shivani M Bhatt
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine M Avitabile
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Division of Cardiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Factors associated with discontinuation of pulmonary vasodilator therapy in children with bronchopulmonary dysplasia-associated pulmonary hypertension. J Perinatol 2022; 42:1246-1254. [PMID: 35676536 DOI: 10.1038/s41372-022-01421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/25/2022] [Accepted: 05/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate factors associated with discontinuation of pulmonary vasodilator therapy in bronchopulmonary dysplasia-related pulmonary hypertension (BPD-PH). STUDY DESIGN Retrospective study of neonatal, echocardiographic, and cardiac catheterization data in 121 infants with BPD-PH discharged on pulmonary vasodilator therapy from 2009-2020 and followed into childhood. RESULT After median 4.4 years, medications were discontinued in 58%. Those in whom medications were discontinued had fewer days of invasive support, less severe BPD, lower incidence of PDA closure or cardiac catheterization, and higher incidence of fundoplication or tracheostomy decannulation (p < 0.05). On multivariable analysis, likelihood of medication discontinuation was lower with longer period of invasive respiratory support [HR 0.95 (CI:0.91-0.99), p = 0.01] and worse RV dilation on pre-discharge echocardiogram [HR 0.13 (CI:0.03-0.70), p = 0.017]. In those with tracheostomy, likelihood of medication discontinuation was higher with decannulation [HR 10.78 (CI:1.98-58.59), p < 0.001]. CONCLUSION In BPD-PH, childhood discontinuation of pulmonary vasodilator therapy is associated with markers of disease severity.
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Dehghan B, Ahmadi A, Sarfarazi Moghadam S, Sabri MR, Ghaderian M, Mahdavi C, Sedighi M, Bigdelian H. Biventricular strain and strain rate impairment shortly after surgical repair of tetralogy of Fallot in children: A case-control study. Health Sci Rep 2022; 5:e613. [PMID: 35517373 PMCID: PMC9063058 DOI: 10.1002/hsr2.613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/23/2022] [Accepted: 02/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background Early biventricular dysfunction in repaired tetralogy of Fallot (TOF) children may lead to poor clinical outcomes. We aimed to assess biventricular function in TOF children before and after surgery by speckle tracking echocardiography (STE) and compare them with the controls. Methods Twenty repaired TOF children and 20 normal children as controls were assessed by STE. Tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF), biventricular strain, and strain rate were compared before and after surgery and between TOF children and controls. Results Postoperative LVEF (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for left ventricle improved significantly compared to preoperative phase. However, postoperative left ventricular strain (p = 0.05) and strain rate (p = 0.01) in TOF children were significantly impaired compared to controls. Postoperative LVEF was correlated inversely with postoperative strain rate (r = −0.40, p = 0.04). Postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.001) for right ventricle significantly worsened when compared with the preoperative phase. Moreover, postoperative TAPSE (p = 0.001), strain (p = 0.001), and strain rate (p = 0.01) were significantly impaired compared to controls. Postoperative right ventricular strain rate was correlated significantly with the weight of children (r = 0.48, p = 0.02), and postoperative left ventricular strain showed significant correlations with aortic clamp time (r = 0.44, p = 0.04) and with ICU stay (r = −0.46, p = 0.04). Conclusion Despite normal LVEF, TOF children exhibit impaired left ventricular strain and strain rate after surgery. TAPSE, strain, and strain rate for the right ventricle worsen after surgical repair. STE‐driven strain can be used to detect early ventricular dysfunction and the associated prognostic implications.
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Affiliation(s)
- Bahar Dehghan
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Alireza Ahmadi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Shima Sarfarazi Moghadam
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Mohammad Reza Sabri
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Mehdi Ghaderian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Chehreh Mahdavi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
| | - Mohsen Sedighi
- Trauma and Injury Research Center Iran University of Medical Sciences Tehran Iran
| | - Hamid Bigdelian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
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Comprehensive evaluation of left ventricular deformation using speckle tracking echocardiography in normal children: comparison of three-dimensional and two-dimensional approaches. Cardiovasc Ultrasound 2022; 20:3. [PMID: 35086543 PMCID: PMC8793178 DOI: 10.1186/s12947-022-00273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Three-dimensional (3D) speckle tracking echocardiography (STE) can overcome some of the inherent limitations of two-dimensional (2D) STE; however, clinical experience is lacking. We aimed to assess and compare the feasibility, agreement, and reproducibility of left ventricular (LV) global longitudinal (GLS), and regional strain by 3D vs 2D STE in normal children. Methods Healthy pediatric subjects (n = 105, age mean = 11.2 ± 5.5 years) were prospectively enrolled. Three-dimensional and 2D LV GLS, as well as regional strain in 16 myocardial segments were quantified. Bland Altman analysis, intra- class correlation coefficients (ICC), percent error and linear regression were used for agreement and correlation between the two techniques. Analysis and acquisition times were compared. Inter- and intra-observer reproducibility was assessed in 20 studies. Results There was good to excellent agreement for 2D and 3D global longitudinal strain (ICC =0.82) and modest agreement for regional strain (ICC range 0.43–0.71). Both methods had high feasibility (88.6% for 2D vs 85.7% for 3D, p = 0.21), although 3D STE required significantly shorter acquisition and analysis time than 2D STE (acquisition time 1 ± 1.2 mins vs 2.4 ± 1 mins; p = 0.03, analysis time = 3.3 ± 1 mins vs 8.2 ± 2.5 mins; p = 0.001, respectively). Inter and intra-observer reproducibility was excellent for GLS by the two techniques (ICC = 0.78–0.93) but moderate to poor for regional strain (ICC = 0.21–0.64). Conclusion Three-dimensional global LV strain is as feasible and reproducible as 2D strain, with good agreement yet significantly more efficient acquisition and analysis. Regional strain is less concordant and 2D and 3D values should not be used interchangeably. 3D LV GLS may represent a viable alternative in evaluation of LV deformation in pediatric subjects. 1. Adequate feasibility of 3D STE in pediatrics; comparable to 2D STE. 2. Significantly shorter acquisition and analysis time for 3D GLS compared to 2D GLS. 3. Excellent agreement between 3D and 2D LV GLS and moderate to poor agreement between regional strain values. 4. Excellent inter and intra-observer reproducibility for GLS by the two techniques, and fair to poor reproducibility for regional strain (higher for apical than basal regions).
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Lee J. Magnetic Resonance Imaging-based Right Ventricular Strain Evaluation. J Cardiovasc Imaging 2022; 30:59-61. [PMID: 35086171 PMCID: PMC8792712 DOI: 10.4250/jcvi.2021.0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jongmin Lee
- Department of Radiology, Kyungpook National University, School of Medicine, Daegu, Korea.
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11
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Srinivasan R, Faerber JA, DeCost G, Zhang X, DiLorenzo M, Goldmuntz E, Fogel M, Mercer-Rosa L. Right Ventricular Strain Is Associated With Increased Length of Stay After Tetralogy of Fallot Repair. J Cardiovasc Imaging 2022; 30:50-58. [PMID: 35086170 PMCID: PMC8792718 DOI: 10.4250/jcvi.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little is known regarding right ventricular (RV) remodeling immediately after Tetralogy of Fallot (TOF) repair. We sought to describe myocardial deformation by cardiac magnetic resonance imaging (CMR) after TOF repair and investigate associations between these parameters and early post-operative outcomes. METHODS Fifteen infants underwent CMR without sedation as part of a prospective pilot study after undergoing complete TOF repair, prior to hospital discharge. RV deformation (strain) was measured using tissue tracking, in addition to RV ejection fraction (EF), volumes, and pulmonary regurgitant fraction. Pearson correlation coefficients were used to determine associations between both strain and CMR measures/clinical outcomes. RESULTS Most patients were male (11/15, 73%), with median age at TOF repair 53 days (interquartile range, 13,131). Most patients had pulmonary stenosis (vs. atresia) (11/15, 73%) and 7 (47%) received a transannular patch as part of their repair. RV function was overall preserved with mean RV EF of 62% (standard deviation [SD], 9.8). Peak radial and longitudinal strain were overall diminished (mean ± SD, 33.80 ± 18.30% and −15.50 ± 6.40%, respectively). Longer hospital length of stay after TOF repair was associated with worse RV peak radial ventricular strain (correlation coefficient (r), −0.54; p = 0.04). Greater pulmonary regurgitant fraction was associated with shorter time to peak radial RV strain (r = −0.55, p = 0.03). CONCLUSIONS In this small study, our findings suggest presence of early decrease in RV strain after TOF repair and its association with hospital stay when changes in EF and RV size are not yet apparent.
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Affiliation(s)
- Ranjini Srinivasan
- Division of Pediatric Cardiology, Hassenfeld Children's Hospital, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer A. Faerber
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Grace DeCost
- School of Public Health, Brown University, Providence, RI, USA
| | - Xuemei Zhang
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael DiLorenzo
- Division of Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University, New York, NY, USA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mark Fogel
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Kidwai M, Azad S, Radhakrishnan S, Garg A, Yadav S, Kumar A. Echocardiographic Assessment of Right Ventricular Systolic Function in Postoperative Tetralogy of Fallot Patients with Special Emphasis on Right Ventricular-Global Longitudinal Strain. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2022. [DOI: 10.4103/jiae.jiae_60_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Cardiac MRI-Derived Myocardial Deformation Parameters Correlate with Pulmonary Valve Replacement Indications in Repaired Tetralogy of Fallot. Pediatr Cardiol 2021; 42:1805-1817. [PMID: 34196756 DOI: 10.1007/s00246-021-02669-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
Right ventricular (RV) volumetric cardiac magnetic resonance (CMR) criteria serve as indicators for pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (rTOF). Myocardial deformation and tricuspid valve displacement parameters may be more sensitive measures of RV dysfunction. This study's aim was to describe rTOF RV deformation and tricuspid displacement patterns using novel CMR semi-automated software and determine associations with standard CMR measures. Retrospective study of 78 pediatric rTOF patients was compared to 44 normal controls. Global RV longitudinal and circumferential strain and strain rate (SR) and tricuspid valve (TV) displacement were measured. Correlation analysis between strain, SR, TV displacement, and volumes was performed between and within subgroups. The sensitivity and specificity of strain parameters in predicting CMR criteria for PVR was determined. Deformation variables were reduced in rTOF compared to controls. Decreased RV strain and TV shortening were associated with increased RV volumes and decreased RVEF. Longitudinal and circumferential parameters were predictive of RVESVi (> 80 ml/m2) and RVEF (< 47%), with circumferential strain (> - 15.88%) and SR (> - 0.62) being most sensitive. Longitudinal strain was unchanged between rTOF subgroups, while circumferential strain trended abnormal in those meeting PVR criteria compared to controls. RV deformation and TV displacement are abnormal in rTOF, and RV circumferential strain variation may reflect an adaptive response to chronic volume or pressure load. This coupled with associations of ventricular deformation with traditional PVR indications suggest importance of this analysis in the evolution of rTOF RV assessment.
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14
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Grau CRPDC. The Challenge of Echocardiography in the Accurate Assessment of the Right Ventricle and Pulmonary Insufficiency. Arq Bras Cardiol 2021; 117:699-700. [PMID: 34709297 PMCID: PMC8528367 DOI: 10.36660/abc.20210744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Claudia R Pinheiro de Castro Grau
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
- Hospital São Luiz Itaim, Rede Dor, São Paulo, SP - Brasil
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15
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Right Ventricular Strain, Brain Natriuretic Peptide, and Mortality in Congenital Diaphragmatic Hernia. Ann Am Thorac Soc 2021; 17:1431-1439. [PMID: 32730099 DOI: 10.1513/annalsats.201910-767oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Rationale: Brain-type natriuretic peptide (BNP) correlates with pulmonary hypertension as demonstrated by echocardiogram in congenital diaphragmatic hernia (CDH); however, its association with right ventricular (RV) function and mortality is unknown.Objectives: To characterize the relationships between echocardiogram-derived RV strain, BNP, and mortality in diaphragmatic hernia.Methods: We performed a single-center retrospective cohort study of infants with CDH and at least one BNP-echocardiogram pair within a 24-hour period. RV global longitudinal strain (GLS) and free-wall strain (FWS) were measured on existing echocardiograms. Associations among strain, BNP, and mortality were tested using mixed-effect linear and logistic regression models. Survival analysis was stratified by BNP and strain abnormalities.Results: There were 220 infants with 460 BNP-echocardiogram pairs obtained preoperatively (n = 237), ≤1 week postoperatively (n = 35), and >1 week postoperatively ("recovery"; n = 188). Strain improved after repair (P < 0.0001 for all periods). Higher BNP level was associated with worse strain in recovery but not before or immediately after operation (estimate [95% confidence interval] for recovery: GLS, 1.03 [0.50-1.57]; P = 0.0003; FWS, 0.62 [0.01-1.22]; P = 0.047). BNP and strain abnormalities were associated with an extracorporeal-membrane oxygenation requirement. Higher BNP level in recovery was associated with greater mortality (odds ratio, 11.2 [1.2-571.3]; P = 0.02). Abnormal strain in recovery had high sensitivity for detection of mortality (100% for GLS; 100% for FWS) but had low specificity for detection of mortality (28% for GLS; 48% for FWS).Conclusions: Persistent RV dysfunction after CDH repair may be detected by a high BNP level and abnormal RV strain.
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Aly D, Ramlogan S, France R, Schmidt S, Hinzman J, Sherman A, Goudar SP, Forsha D. Intervendor Agreement for Right Ventricular Global Longitudinal Strain in Children. J Am Soc Echocardiogr 2021; 34:786-793. [PMID: 33561494 DOI: 10.1016/j.echo.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Right ventricular global longitudinal strain (RVGLS) has emerged as an important technique for clinical evaluation of (RV) function. The routine application of RVGLS in pediatrics remains limited by a lack of data on agreement between vendors. The aim of this study was to investigate intervendor agreement for RVGLS between the two commonly used analysis vendors in pediatrics, hypothesizing that RVGLS has good intervendor agreement, although it is likely lower than intravendor agreement (inter- and intraobserver reproducibility). METHODS Seventy infants and children with normal cardiac anatomy and varying ventricular function were included after prospectively obtaining RV-focused four-chamber apical images on the GE Vivid E95. Images were analyzed for RVGLS at acquired frame rates in EchoPAC (GE) and TomTec (TT) and in the compressed Digital Imaging and Communications in Medicine format in TT. Intraclass correlation coefficients and Bland-Altman plots were used to test intervendor agreement and intravendor reproducibility. RESULTS RVGLS measurements were equally feasible using TT and EchoPAC analysis (92%). There was good to excellent agreement for RVGLS between TT and EchoPAC analysis, with a relatively higher intraclass correlation coefficient between GE and TT at the acquired frame rate (0.85) than between GE and TT at the compressed frame rate (0.75) and significantly higher agreement in patients with abnormal RV function (0.7-0.9) than those with normal function (0.4-0.6). Intra- andinterobserver reproducibility for RVGLS was excellent (intraclass correlation coefficient = 0.74-0.96). Heart rate ≥ 100 beats/min and acquisition frame rate/heart rate ≤ 0.7 were associated with diminished agreement, especially when compressed data were involved. CONCLUSIONS RVGLS analyzed using EchoPAC and TT show good agreement, especially when analyzed at acquisition frame rates and in the setting of abnormal RV function. Otherwise, RVGLS should ideally be analyzed using the same vendor, and intervendor comparisons should be undertaken with caution, particularly if data are in a compressed format.
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Affiliation(s)
- Doaa Aly
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Sandhya Ramlogan
- Children's Heart Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Rita France
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Stephanie Schmidt
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Julie Hinzman
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Ashley Sherman
- Division of Biostatistics, Children's Mercy Hospital, Kansas City, Missouri
| | - Suma P Goudar
- Children's National Heart Institute, Washington, District of Columbia
| | - Daniel Forsha
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri.
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17
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Schiavone NK, Elkins CJ, McElhinney DB, Eaton JK, Marsden AL. In Vitro Assessment of Right Ventricular Outflow Tract Anatomy and Valve Orientation Effects on Bioprosthetic Pulmonary Valve Hemodynamics. Cardiovasc Eng Technol 2021; 12:215-231. [PMID: 33452649 DOI: 10.1007/s13239-020-00507-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 12/02/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE The congenital heart defect Tetralogy of Fallot (ToF) affects 1 in 2500 newborns annually in the US and typically requires surgical repair of the right ventricular outflow tract (RVOT) early in life, with variations in surgical technique leading to large disparities in RVOT anatomy among patients. Subsequently, often in adolescence or early adulthood, patients usually require surgical placement of a xenograft or allograft pulmonary valve prosthesis. Valve longevity is highly variable for reasons that remain poorly understood. METHODS This work aims to assess the performance of bioprosthetic pulmonary valves in vitro using two 3D printed geometries: an idealized case based on healthy subjects aged 11 to 13 years and a diseased case with a 150% dilation in vessel diameter downstream of the valve. Each geometry was studied with two valve orientations: one with a valve leaflet opening posterior, which is the native pulmonary valve position, and one with a valve leaflet opening anterior. RESULTS Full three-dimensional, three-component, phase-averaged velocity fields were obtained in the physiological models using 4D flow MRI. Flow features, particularly vortex formation and reversed flow regions, differed significantly between the RVOT geometries and valve orientations. Pronounced asymmetry in streamwise velocity was present in all cases, while the diseased geometry produced additional asymmetry in radial flows. Quantitative integral metrics demonstrated increased secondary flow strength and recirculation in the rotated orientation for the diseased geometry. CONCLUSIONS The compound effects of geometry and orientation on bioprosthetic valve hemodynamics illustrated in this study could have a crucial impact on long-term valve performance.
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Affiliation(s)
| | | | | | - John K Eaton
- Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Alison L Marsden
- Pediatrics and Bioengineering, Stanford University, Stanford, CA, USA.
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Monti CB, Secchi F, Capra D, Guarnieri G, Lastella G, Barbaro U, Carminati M, Sardanelli F. Right ventricular strain in repaired Tetralogy of Fallot with regards to pulmonary valve replacement. Eur J Radiol 2020; 131:109235. [PMID: 32919263 DOI: 10.1016/j.ejrad.2020.109235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/01/2020] [Accepted: 08/10/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess right ventricular (RV) myocardial strain both globally and segmentally through feature-tracking cardiac magnetic resonance (CMR) in patients with Tetralogy of Fallot (ToF), with regards to pulmonary valve replacement (PVR). METHODS After Ethics Committee approval, we retrospectively included 46 consecutive ToF patients who had two CMR examinations performed at our institution between March 2014 and June 2019. We divided patients into those who had not undergone PVR between the two CMR examinations (Group-0), and those who had (Group-1). Ventricular volumes were quantified on cine sequences, and strain was calculated through feature-tracking, using the previously traced segmentations. RV longitudinal and radial strain were assessed both globally and separately for the septum and free wall. Variations were normalized for intercurrent years, differences were appraised with t-tests or Mann-Whitney U. RESULTS 30 patients belonged to Group-0 and 16 to Group-1. Median age was 22 years (interquartile range [IQR] 17-29 years) in Group-0, and 21 years (IQR 16-29 years) in Group-1. No significant differences were reported in RV strain between groups (p ≥ 0.254) except for RV septal radial strain, significantly higher (p = 0.010) in Group-0 (24.2 %, IQR 10.1-52.4 %) than in Group-1 (6.0 %, IQR -3.3-23.3 %) at the second CMR. Both global and segmental RV strains decreased over time in both groups, and yearly variations did not differ significantly (p ≥ 0.081) between groups. CONCLUSIONS While PVR performed at the appropriate timing eases the burden on the RV allowing for a reduction in volumes, RV strain seems to continuously deteriorate as in patients who do not undergo PVR.
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Affiliation(s)
- Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Gianluca Guarnieri
- Corso di Laurea in Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy.
| | - Giulia Lastella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy.
| | - Ugo Barbaro
- Department of Radiology, IRCCS Centro Neurolesi "Bonino Pulejo", Viale Europa 45, 98124, Messina, Italy.
| | - Mario Carminati
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.
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Sánchez Ramírez CJ, Pérez de Isla L. Tetralogy of Fallot: cardiac imaging evaluation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:966. [PMID: 32953766 PMCID: PMC7475417 DOI: 10.21037/atm.2020.02.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Thanks to advances in pediatric cardiology, most infants with tetralogy of Fallot (TOF) now survive into adulthood. This relatively new population of adult patients may face long-term complications, including pulmonary regurgitation (PR), right ventricular (RV) tract obstruction, residual shunts, RV dysfunction, and arrythmias. They will often need to undergo pulmonary valve (PV) replacement and other invasive re-interventions. However, the optimal timing for these procedures is challenging, largely due to the complexity of evaluating RV volume and function. The options for the follow-up of these patients have rapidly evolved from an angiography-based approach to the surge of advanced imaging techniques, mainly echocardiography, cardiac magnetic resonance (CMR), and computer tomography (CT). In this review, we outline the indications, strengths and limitations of these modalities in the adult TOF population.
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Affiliation(s)
| | - Leopoldo Pérez de Isla
- Department of Cardiac Imaging, Hospital Clínico San Carlos, Professor Martín Lagos, Madrid, Spain
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20
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Ventricular Myocardial Deformation Imaging of Patients with Repaired Tetralogy of Fallot. J Am Soc Echocardiogr 2020; 33:788-801. [PMID: 32624088 DOI: 10.1016/j.echo.2020.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/22/2022]
Abstract
In patients with repaired tetralogy of Fallot (TOF), dysfunction of the right and left ventricles remains an important issue. Adverse right ventricular (RV) remodeling has been related to RV dilation secondary to pulmonary regurgitation, electromechanical dyssynchrony, and myocardial fibrosis. Left ventricular (LV) dysfunction is attributed among other factors to altered ventricular-ventricular interaction. Advancements in echocardiography and cardiac magnetic resonance imaging have enabled direct interrogation of myocardial deformation of both ventricles in terms of myocardial strain and strain rate. Emerging evidence suggests that myocardial deformation imaging may provide incremental information for clinical use. In children and adults with repaired TOF, there is a growing body of literature on the use of myocardial deformation imaging in the assessment of ventricular mechanics and its clinical and prognostic values. The present review aims to provide an overview of impairment in RV and LV mechanics, associations between RV and LV deformation, changes in ventricular deformation after pulmonary valve replacement, and associations between measures of RV and LV deformation and outcomes and to highlight the clinical translational potential of myocardial deformation imaging in patients with repaired TOF.
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Frogoudaki AA, Pantelakis I, Bistola V, Kroupis C, Birba D, Ikonomidis I, Alexopoulos D, Filippatos G, Parissis J. Global Longitudinal Strain of the Systemic Ventricle Is Correlated with Plasma Galectin-3 and Predicts Major Cardiovascular Events in Adult Patients with Congenital Heart Disease. ACTA ACUST UNITED AC 2020; 56:medicina56060305. [PMID: 32580463 PMCID: PMC7353898 DOI: 10.3390/medicina56060305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/09/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
Abstract
Backround and Objective: We sought to assess in adult congenital heart disease (ACHD) patients the prognostic value of plasma galectin-3 (Gal-3) levels and systemic ventricular global longitudinal strain (SV GLS) as well as their association with NTproBNP and arrhythmogenesis. Materials and Methods: We studied 58 patients (26 men, mean age 37 ± 16.8 years) with various congenital heart diseases. Patients underwent echocardiogram, 24 h ambulatory ECG monitoring, while NTproBNP and Gal-3 were measured. They were followed up (median of 790.5 days -IQR 350.3 days) and major cardiovascular events (MACE) were recorded. Results. Mean Gal-3 levels were 17.07 ± 6.38 ng/m. Plasma Gal-3 was correlated with LogNTproBNP (r = 0.456, p = 0.001).Gal-3 levels associated with supraventricular tachycardia (SVT) (p < 0.001) and ventricular tachycardia (VT) (p < 0.001), but was not associated with MACE (HR 1.018, 95% CI 0.944-1.098, p = 0.641).Mean SVGLS in patients with systemic left ventricle was -15.91% ± 4.09%, which was significantly lower compared to patients with systemic right ventricle and patients with single ventricle (-11.42% ± 3.37% and -11.9% ± 5.06%, respectively, p = 0.021).SV GLS correlated with plasma Gal-3 (r = 0.313, p = 0.027) and logNTproBNP (r = 0.479, p < 0.001). SVGLS correlated with VT arrhythmias (p = 0.004). NTproBNP predicted MACE (AUC 0.750, p = 0.03). SVGLS also predicted MACE (AUC 0.745, p = 0.03. In multivariate analysis, SVGLS and logNTproBNP maintained their predictive value (p = 0.004 and p = 0.009, respectively) Conclusion: In ACHD patients, SV GLS was found to predict MACE independently from NTproBNP and correlated with VT. Gal-3 correlated with NTproBNP and SVGLS as well as SVT and VT, but has not been shown to bear significant prognostic potential.
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Affiliation(s)
- Alexandra A. Frogoudaki
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
- Correspondence: ; Tel.: +30-69-7441-3918; Fax: +30-21-0583-2351
| | - Ioannis Pantelakis
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
| | - Vasiliki Bistola
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
| | - Christos Kroupis
- Department of Clinical Biochemistry, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece;
| | - Dionysia Birba
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
| | - Ignatios Ikonomidis
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
| | - Dimitrios Alexopoulos
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
| | - Gerasimos Filippatos
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
- Medical School, University of Cyprus, 2029 Nicosia, Cyprus
| | - John Parissis
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
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Hui W, Slorach C, Iori S, Dragulescu A, Mertens L, Friedberg MK. The right ventricular myocardial systolic-to-diastolic duration ratio in children after surgical repair of Tetralogy of Fallot. J Appl Physiol (1985) 2020; 128:1677-1683. [PMID: 32437247 DOI: 10.1152/japplphysiol.00775.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Right ventricular (RV) function impacts clinical outcomes after surgical repair of Tetralogy of Fallot (rTOF). However, assessment of RV function remains difficult. We investigated the RV myocardial systolic-to-diastolic (S/D) duration ratio derived from strain imaging time intervals to characterize RV myocardial performance, exploring its relation with peak oxygen consumption during exercise (V̇o2) and cardiac magnetic resonance-derived RV dilation and function in rTOF. We retrospectively analyzed 76 children with rTOF and 42 normal controls. The RV myocardial S/D duration ratio was measured from RV global and regional 2D speckle tracking longitudinal strain. Time from QRS onset to peak systolic strain was defined as the systolic duration. The S/D duration ratio was calculated and corrected for heart rate (HR). Postsystolic shortening (PSS) duration was defined as shortening time after cessation of pulmonary systolic antegrade flow. The RV myocardial S/D duration ratio, corrected or uncorrected for HR, was significantly higher in rTOF vs. controls (1 ± 0.3 vs. 0.8 ± 0.2, P = 0.004) in relation to prolonged PSS. The HR-corrected myocardial S/D duration ratio correlated weakly with RV ejection fraction (EF, r = -0.37, P = 0.001) and V̇o2 (r = -0.32, P = 0.042). In multiregression analysis, RV EF was independently associated with the myocardial S/D duration ratio. The RV myocardial S/D duration ratio is a parameter of RV myocardial performance and efficiency, incorporating elements of systolic and diastolic performance, mechanical dyssynchrony, and PSS. The S/D duration ratio is associated with exercise capacity and RV dysfunction in rTOF.NEW & NOTEWORTHY This is the first study to assess right ventricular myocardial performance using the systolic-to-diastolic duration ratio derived from 2D strain. Seventy-six children with repaired Tetralogy of Fallot were evaluated. Echocardiographic data were correlated with cardiac magnetic resonance and peak oxygen consumption during exercise. The results show the right ventricular myocardial systolic-to-diastolic duration ratio incorporates systolic and diastolic performance, electromechanical dyssynchrony, and postsystolic shortening and is associated with exercise capacity in repaired Tetralogy of Fallot.
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Affiliation(s)
- Wei Hui
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children and University of Toronto, Canada
| | - Cameron Slorach
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children and University of Toronto, Canada
| | - Susan Iori
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children and University of Toronto, Canada
| | - Andreea Dragulescu
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children and University of Toronto, Canada
| | - Luc Mertens
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children and University of Toronto, Canada
| | - Mark K Friedberg
- Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children and University of Toronto, Canada
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Savla JJ, Faerber JA, Huang YSV, Zaoutis T, Goldmuntz E, Kawut SM, Mercer-Rosa L. 2-Year Outcomes After Complete or Staged Procedure for Tetralogy of Fallot in Neonates. J Am Coll Cardiol 2020; 74:1570-1579. [PMID: 31537267 DOI: 10.1016/j.jacc.2019.05.057] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is ongoing debate about the best strategy to treat patients with tetralogy of Fallot who are symptomatic in the neonatal period. OBJECTIVES The aim of this study was to compare the outcomes of complete versus staged surgery (i.e., initial palliative procedure for possible later complete repair). METHODS A retrospective cohort study was performed using the Pediatric Health Information System database, including patients who underwent complete or staged tetralogy of Fallot repair prior to 30 days of age. The primary outcome was death during 2-year follow-up after the initial procedure. Inverse probability-weighted Cox and logistic regression models were used to examine the association between surgical approach group and mortality while accounting for patient- and hospital-level factors. Causal mediation analyses examined the role of intermediate variables. RESULTS A total of 2,363 patients were included (1,032 complete and 1,331 staged). There were 239 deaths. Complete neonatal repair was associated with a significantly higher risk for mortality during the 2-year follow-up period (hazard ratio: 1.51; 95% confidence interval: 1.05 to 2.06), between 7 and 30 days after the initial procedure (hazard ratio: 2.29; 95% confidence interval: 1.18 to 4.41), and during the initial hospital admission (odds ratio: 1.72; 95% confidence interval: 1.15 to 2.62). Post-operative cardiac complications were more common in the complete repair group and mediated the differences in 30-day and 2-year mortality. CONCLUSIONS Complete surgical repair for neonates with tetralogy of Fallot is associated with a significantly higher risk for early and 2-year mortality compared with the staged approach, after accounting for patient and hospital characteristics. Post-operative cardiac complications mediated these findings.
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Affiliation(s)
- Jill J Savla
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia
| | - Jennifer A Faerber
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yuan-Shung V Huang
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Theoklis Zaoutis
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth Goldmuntz
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia
| | - Steven M Kawut
- Department of Medicine and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia.
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24
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Huntgeburth M, Germund I, Geerdink LM, Sreeram N, Udink Ten Cate FEA. Emerging clinical applications of strain imaging and three-dimensional echocardiography for the assessment of ventricular function in adult congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S326-S345. [PMID: 31737540 DOI: 10.21037/cdt.2018.11.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Management of congenital heart disease (CHD) in adults (ACHD) remains an ongoing challenge due to the presence of residual hemodynamic lesions and development of ventricular dysfunction in a large number of patients. Echocardiographic imaging plays a central role in clinical decision-making and selection of patients who will benefit most from catheter interventions or cardiac surgery.. Recent advances in both strain imaging and three-dimensional (3D)-echocardiography have significantly contributed to a greater understanding of the complex pathophysiological mechanisms involved in CHD. The aim of this paper is to provide an overview of emerging clinical applications of speckle-tracking imaging and 3D-echocardiography in ACHD with focus on functional assessment, ventriculo-ventricular interdependency, mechanisms of electromechanical delay, and twist abnormalities in adults with tetralogy of Fallot (TOF), a systemic RV after atrial switch repair or in double discordance ventricles, and in those with a Fontan circulation.
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Affiliation(s)
- Michael Huntgeburth
- Center for Grown-ups with congenital heart disease (GUCH), Clinic III for Internal Medicine, Department of Cardiology, Heart Center, University Hospital of Cologne, Germany
| | - Ingo Germund
- Department of Pediatric Cardiology, Heart Center, University Hospital of Cologne, Germany
| | - Lianne M Geerdink
- Academic Center for Congenital Heart Disease (ACAHA), Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen.,Division of Pediatric Cardiology, Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, Heart Center, University Hospital of Cologne, Germany
| | - Floris E A Udink Ten Cate
- Academic Center for Congenital Heart Disease (ACAHA), Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen.,Division of Pediatric Cardiology, Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
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25
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Hu L, Sun A, Guo C, Ouyang R, Wang Q, Yao X, Zhong Y. Assessment of global and regional strain left ventricular in patients with preserved ejection fraction after Fontan operation using a tissue tracking technique. Int J Cardiovasc Imaging 2018; 35:153-160. [DOI: 10.1007/s10554-018-1440-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/13/2018] [Indexed: 01/27/2023]
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